Right atrial to left atrial shunt through foramen ovale during pneumoperitoneum for laparoscopic cholecystectomy

1994 ◽  
Vol 8 (9) ◽  
pp. 1110-1112 ◽  
Author(s):  
K. Iwase ◽  
T. Takao ◽  
H. Watanabe ◽  
Y. Tanaka ◽  
T. Kido ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Left Atrial ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Atrial Shunt

Left Atrial-to-Right Atrial Shunt without Atrial Septal Defect or Precordial Murmur

CHEST Journal ◽  
1982 ◽  
Vol 81 (1) ◽  
pp. 91-94
Author(s):  
Frank C. Brosius ◽  
David E. Schwartz ◽  
William L. Gleason ◽  
Barry Maron ◽  
Michael Jones ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrial ◽  
Septal Defect ◽  
Right Atrial ◽  
Atrial Shunt

scholarly journals Stepwise Progression of Right-to-Left Atrial Shunting through a Combination of Patent Foramen Ovale and Tricuspid Regurgitation

2016 ◽  
Vol 43 (2) ◽  
pp. 171-174
Author(s):  
Evan P. Kransdorf ◽  
Lisa N. Kransdorf ◽  
F. David Fortuin ◽  
John P. Sweeney ◽  
Susan Wilansky
Keyword(s):  
Tricuspid Regurgitation ◽  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Severe Tricuspid Regurgitation ◽  
Occluder Device ◽  
Clinically Significant ◽  
Ischemic Attack ◽  
Common Clinical Finding

Patent foramen ovale is a common clinical finding that generally becomes a concern in the presence of transient ischemic attack or stroke. Rarely, patent foramen ovale is associated with hypoxemia in the presence of substantial right-to-left atrial shunting. We present the case of an 86-year-old woman with a pacemaker, who was initially asymptomatic notwithstanding a patent foramen ovale. Over 1.5 years, her symptoms progressed in a stepwise fashion, in the setting of progressive pacemaker-associated tricuspid regurgitation. Ultimately, the patient's symptoms and her hypoxemia resolved after percutaneous closure of her patent foramen ovale with use of a 25-mm “Cribriform” occluder device. This case highlights the fact that clinically significant right-to-left shunting requires an anatomic lesion, such as patent foramen ovale, together with elevated right atrial pressure, which in this case was contributed by severe tricuspid regurgitation.

scholarly journals P1699 A case of atrial myxoma presenting with acute stroke

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Gray ◽  
J Brassil ◽  
N Jepson
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Signal Intensity ◽  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Atrial Myxoma ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Apical Hypertrophic Cardiomyopathy ◽  
Right Atrial Myxoma

Abstract A 73-year-old female presented with sudden reduced level of consciousness on the background of rheumatoid arthritis and dyslipidaemia. On examination she had a Glascow Coma Score of 12 and an irregularly irregular pulse. The electrocardiograph confirmed atrial fibrillation and showed widespread T wave inversion. A computed tomography cerebral angiogram showed an acute basilar artery occlusion. She was transferred to a tertiary centre where she had successful endovascular clot retrieval. An urgent transthoracic echocardiogram (figure 1) showed apical hypertrophy, normal systolic function and a large right atrial mass. The left atrial size was normal. A transoesophageal echocardiogram (figure 3) confirmed a large pedunculated mobile mass with a hypermobile septum consistent with a patent foramen ovale. There was no right to left doppler flow, however the atrial mass obstructed the course, and a bubble study was positive. The cardiac magnetic resonance image (figure 2) showed a 47 x 48 mm pedunculated lesion within the right atrium, arising from the intraventricular septum, demonstrating moderate T2 signal intensity, and intermediate T1 signal intensity, with avid enhancement, consistent with a right atrial myxoma. There was increased apical wall thickening at 15mm which confirmed apical hypertrophic cardiomyopathy. An open surgical resection and left atrial appendage ligation was performed on day 11 of admission. Histopathology confirmed an atrial myxoma. She had an excellent neurological recovery with only mild diplopia. The mechanism of stroke was likely atrial fibrillation secondary to increased left atrial pressure from apical hypertrophic cardiomyopathy. However, the unexpected finding of a right atrial myxoma with a corresponding patent foramen ovale provides a second possible mechanism. Abstract P1699 Figure. Right atrial Myxoma

Distribution of fetal cardiac output: importance of pacemaker location

1976 ◽  
Vol 231 (1) ◽  
pp. 204-208 ◽  
Author(s):  
PT Pitlick ◽  
SE Kirkpatrick ◽  
WF Friedman
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Left Atrial ◽  
Left Ventricular ◽  
Right Atrial ◽  
Atrial Pacing ◽  
Foramen Ovale ◽  
Rate Versus ◽  
Left Ventricular Output ◽  
The Right

Important questions exist about the relative roles of changes in heart rate versus extent of myocardial shortening in regulating fetal cardiac output, because increases in heart rate created by left atrial pacing have been shown to increase right ventricular output and decrease left ventricular output. Since the pacemaker site could importantly influence foramen ovale flow and, hence, each ventricle's output, changes in individual ventricular outputs were examined when both the right and left atria were paced at a rate of 270 beats/min in five acute and in eight chronically instrumented fetal lamb studies. With pacing of either atrium, total cardiac output was unchanged compared to control values. However, the right ventricle contributed more to total cardiac output with left atrial pacing (73% acute, 65% chronic) than with right atrial pacing (51% acute, 57% chronic). Converse changes were observed in left atrial pacing (27% acute, 35% chronic) as compared to right atrial pacing (49% acute, 43% chronic). Thus the disparity that exists normally in the contributions of the right and left ventricles to total cardiac output is accentuated with left atrial pacing and minimized with right atrial pacing. Pressure measurements demonstrated changes in the atrial pressure relations that would be expected to alter flow across the foramen ovale depending on the chamber initially activated. Previous experimental differences can, therefore, be attributed to changes in the magnitude of shunting across the foramen ovale and depend on pacemaker location.

Intravenous fluid loading as prophylaxis for paradoxical air embolism

1985 ◽  
Vol 62 (6) ◽  
pp. 839-842 ◽  
Author(s):  
Austin R. T. Colohan ◽  
Nancy A. K. Perkins ◽  
Robert F. Bedford ◽  
John A. Jane
Keyword(s):  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Air Embolism ◽  
Intravenous Fluid ◽  
Atrial Pressure ◽  
Fluid Replacement ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Fluid Loading ◽  
Pulmonary Capillary

✓ Paradoxical cerebral air embolism has been described in neurosurgical operations performed on patients in the seated position. This problem is thought to result most often from a probe-patent foramen ovale. It has been postulated that right atrial pressure exceeds left atrial pressure when paradoxical air embolism occurs. A study is described in which intravenous fluid loading is compared with routine fluid management in 20 patients undergoing neurosurgical operations in the seated position. In order to investigate if intravenous fluid loading would decrease the risk of paradoxical air embolism during neurosurgical operations on seated patients, 20 patients were assigned randomly to two groups: 10 patients received normal intravenous fluid replacement (1220 ± 102 ml), and 10 received augmented fluid replacement (2800 ± 400 ml). Right atrial and pulmonary capillary pressures were monitored for evidence of an interatrial pressure gradient that would force air emboli from the right atrium into the left atrium via a probe-patent foramen ovale. Four of 10 patients receiving routine fluid administration developed right atrial pressure greater than pulmonary capillary wedge pressure (and hence, indirectly, greater than left atrial pressure), whereas none of the 10 patients with augmented fluid loading developed this condition (p = 0.04). The authors conclude that augmented intravenous fluid loading may be effective in preventing systemic air embolism during neurosurgical operations performed on patients in the seated position.

Stroke Prophylaxis by Percutaneous Closure of Patent Foramen Ovale and Left Atrial Appendage

2011 ◽  
Vol 6 (1) ◽  
pp. 67
Author(s):  
Antonio L Bartorelli ◽  
Claudio Tondo ◽  
◽  
Keyword(s):  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Stroke Risk ◽  
Left Atrial Appendage ◽  
Cryptogenic Stroke ◽  
Atrial Appendage ◽  
Foramen Ovale ◽  
Percutaneous Procedures ◽  
Cerebrovascular Events

Innovative percutaneous procedures for stroke prevention have emerged in the last two decades. Transcatheter closure of the patent foramen ovale (PFO) is performed in patients who suffered a cryptogenic stroke or a transient ischaemic attach (TIA) in order to prevent recurrence of thromboembolic events. Percutaneous occlusion of the left atrial appendage (LAA) has been introduced to reduce stroke risk in patients with atrial fibrillation (AF). The role of PFO and LAA in the occurrence of cerebrovascular events and the interventional device-based therapies to occlude the PFO and LAA are discussed.

Prenatal ultrasound diagnosis of pulmonary atresia in combination with left atrial isomerism

2017 ◽  
Author(s):  
M Medvedev, M.V. Kubrina, O.S. Zarubina et all
Keyword(s):  
Left Atrial ◽  
Reverse Flow ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Prenatal Ultrasound ◽  
Ultrasound Diagnosis ◽  
Right Atrial ◽  
Second Trimester ◽  
Left And Right ◽  
Atrial Isomerism

Two cases of prenatal ultrasound diagnosis of left atrial isomerism in the second trimester of gestation is presented. These two cases were in combination with pulmonary atresia and right aortic arch. Left atrial isomerism was identify by the digit-like shape of the left and right atrial appendages. The pulmonary atresia was identified on the basis of reverse flow in small pulmonary artery. A right aortic was identified by “U”-shaped confluence of aorta and ductus arteriosus in view of three vessels and trachea. The trachea was located between the vessels. The pregnancies were terminated and prenatal diagnosis was conformed at autopsy

scholarly journals The effects of doxorubicin on left and right atrial mechanics in patients with lymphoma

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Vahabi ◽  
E Kharati-Koopaei ◽  
M Stewart ◽  
H Hancock ◽  
M Norouzi ◽  
...  
Keyword(s):  
Strain Rate ◽  
Left Atrial ◽  
Left Ventricular ◽  
Right Atrial ◽  
Lv Function ◽  
Compensatory Mechanism ◽  
Research Association ◽  
Anthracycline Cardiotoxicity ◽  
Diastolic Strain Rate ◽  
Significant Change

Abstract Background Despite the associated dose-dependent cardiotoxicity, anthracyclines continue to form the backbone of modern chemotherapy regimens. Speckle Tracking Echocardiography (STE) has been a popular method of quantifying cardiac function but most studies have focused on left ventricular function. Research into the effects of anthracyclines on left atrial (LA) and right atrial (RA) function continues to be neglected. Purpose To investigate the effects of doxorubicin, a commonly used anthracycline, on both the LA and RA systolic and diastolic strain and strain-rate parameters in two groups of patients with lymphoma: Group 1 (G1) with a conventional drop in ejection fraction (EF <53%), and Group 2 (G2) without. Methods We retrospectively studied 46 patients treated for lymphoma between 2015 and 2018; G1 (n=12) and G2 (n=34). Echocardiograms performed at baseline (T0), mid-chemotherapy (T1), and post-chemotherapy (T2), were analysed by using offline vendor-independent software (TomTec, 2D Cardiac Performance Analysis). Using 2D STE, LA and RA reservoir, conduit and contractile strains, systolic and diastolic strain-rates were measured. Multi-level longitudinal model was used for statistical analysis.This study was ethically approved by the Health Research Association (REC Reference 18/SS/0139). Results Median age was 64 years (IQR 51–74 years) in G1, and 65 years (IQR 57–73 years) in G2. In G1, there was no significant change in LA reservoir strain with time, however a significant decline with an average mean difference of −7.52 was seen between T0 to T2 (p=0.016) in G2. LA conduit strain did not significantly change in either group with incremental doses of doxorubicin. However, LA contraction strain was seen to significantly increase in G1 between T1 to T2 (p=0.045) with an average change of 7.23. LA peak systolic strain rate, and late diastolic strain rate did not show any significant change with time in both groups. Yet, a significant increase was seen in LA early diastolic strain rate between T0 to T2 (p=0.017) in G1 but not G2. No significant changes were seen in the RA strain parameters in both groups. Conclusion In patient with a reduction in LV function, a significant change was noted in the left atrial contraction strain and early diastolic strain rate with incremental doses of doxorubicin. These changes shows the close relationship between the LA and LV, and the importance of LA in providing a compensatory mechanism for a decline in LV function secondary to anthracycline cardiotoxicity. Funding Acknowledgement Type of funding source: None

Cobra head deformity of atrial septal occluder: blessing in disguise

2020 ◽  
pp. 1-2
Author(s):  
Uma Devi Karuru ◽  
Saurabh Kumar Gupta
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrial ◽  
Septal Defect ◽  
Atrial Septum ◽  
Right Atrial ◽  
Septal Occluder Device ◽  
Occluder Device ◽  
The Right

Abstract It is not uncommon to have prolapse of the atrial septal occluder device despite accurate measurement of atrial septal defect and an appropriately chosen device. This is particularly a problem in cases with large atrial septal defect with absent aortic rim. Various techniques have been described for successful implantation of atrial septal occluder in such a scenario. The essence of all these techniques is to prevent prolapse of the left atrial disc through the defect while the right atrial disc is being deployed. In this brief report, we illustrate the use of cobra head deformity of the device to successfully deploy the device across the atrial septum.

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